[Development of bilateral Kayser-Fleischer rings in a patient operated on by radial keratotomies].
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Biomedical subjects
Publications and source records attributed to J Colin.
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Although several drugs are available to treat superficial herpes simplex keratitis, viral latency and recurrences represent clinical challenges that have been inadequately addressed by current topical antiviral agents. One hundred and ninety patients with previous herpes simplex keratitis were entered in an open study to evaluate the efficacy of the prophylactic therapy of recurrence with Acyclovir (200 mg) four times daily for 1 month to 24 months. Forty patients were treated because of frequently recurring herpetic keratitis; 36 were treated during a short period because of known risk factors; 23 were treated after ocular surgery which needed topical corticosteroid therapy in the postoperative period and 91 patients were treated after penetrating keratoplasty for herpetic keratitis. The results of this study indicate that oral Acyclovir significantly lowered the incidence of recurrences of herpetic keratitis in selected patients.
Acanthamoeba keratitis is now a well-known entity. However most studies report deep keratitis. We present 4 cases of superficial amebic keratitis in contact lens wearers. Clinical aspects were linear, polymorphous alterations of the corneal epithelium. All patients healed with a combination of debridement of the epithelial lesions and Brolene eye drops. Our cases demonstrate that early diagnosis with early treatment allow healing of superficial amebic keratitis.
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Four consecutive epidemics of keratoconjunctivitis caused by adenovirus 8 (Ad8) occurred over a 5-year period in Brest, France. A selection of 30 strains isolated during this period was studied by DNA restriction enzyme analysis using nine restriction enzymes. BglI and SacI were the most discriminative enzymes and allowed the recognition of four DNA variants, all different from the prototype strain Trim. Within each of the epidemics, the strains tested could not be distinguished in this analysis. Between strains from different epidemics differences in DNA structure could be detected however. Thus, the Ad8 epidemics of 1983/1984, 1984, 1987, and 1988 appear to have been due to DNA variants Ad8/D7, D8, D9, and D10, respectively. These results demonstrate that the DNA of Ad8 seems to display a considerable variability, comparable to that observed with Ad7 and Ad21. As has been described for Ad7, Ad21 and Ad41, successive DNA variants of Ad8 prevail during one or more years, and are then replaced by other, newly emerging variants sometimes associated with epidemics.
Keratoconjunctivitis sicca is usually part of Sjögren's syndrome (SS) which is systemic disease. Ocular surface lesions are ascribed either to the reduction, or to to the low quality of tears. To address this question, ocular surface lesions were evaluated in 20 SS patients by the rose bengal test (RBT). The results were compared to those obtained in 20 normal volunteers and collated with the quality (estimated by the break-up-time) and the quantity of tears (estimated by the shirmer's I test and the level of lacrimal lactoferrin, LF). The RBT scores did not correlate with the shirmer's test results, neither did they with the break-up times. This is consistent with the view that Schirmer's I Test and break-up-time cannot make any distinction between patients from controls. In contrast, the RBT scores correlated well with the levels lacrimal LF and paralleled to serological abnormalities.
Five eyes had a delayed refractive regression following myopic epikeratoplasty; the undercorrection ranged between -8.00 and -10.00 diopters. Four of the 5 eyes had a loss of best spectacle visual acuity of two Snellen lines or more. Excimer laser photorefractive keratectomy was performed to achieve a full refractive correction. A dense subepithelial haze was observed in the 5 eyes. The 3 months postoperative refraction ranged between -1.00 D and +2.50 D but the spectacle corrected visual acuity reached only 0.1 to 0.2. Because of the poor visual acuity results, the five epikeratoplasty lenticles were removed, resulting in restoration of best preoperative spectacle visual acuity in 4 of the 5 eyes. Excimer laser photorefractive keratectomy was not a helpful means of correcting residual high myopia after myopic epikeratoplasty. The poor results may be explained by the preexisting stromal abnormalities.
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In the present prospective study, we compared the results of cataract surgery in two groups with or without exfoliation syndrome; 210 eyes were studied. The preoperative pupillary dilatation was smaller in the group with exfoliation syndrome (SE). We noticed a higher incidence of complications during planned extracapsular cataract extraction in patients with SE. A pupillary diameter smaller than 6 mm increases the incidence of capsulozonular rupture (22.5%) in these patients. After surgery, an inflammatory reaction and a transient increase in intraocular pressure were more frequent and the visual results were less favourable in the group with SE. The exfoliation syndrome is a major risk factor for cataract surgery. We recommend extracapsular extraction associated with a sector iridectomy when the pupillary diameter measures less than 6 mm.
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Eighteen patients with typical Herpes simplex virus dendritic keratitis confirmed by viral isolation were treated with corneal collagen shields presoaked with trifluorothymidine for 15 minutes and trifluorothymidine eye drops 5 times daily. The average healing time was 2.9 days (range 1-7 days). No allergic reactions were observed. Toxic punctate keratitis occurred in 3 eyes. The results of this open study suggest that the effect of collagen corneal shields in conjunction with trifluorothymidine shortens the average epithelial healing time compared with other studies that have used antiviral drugs alone.
Evaluation of multifocal IOLs suggests the possibility of two retinal images, one for near and one for distant vision. But the optic principles of multifocal IOLs created overlying images and incident light division. We performed this study to evaluate visual acuity and contrast sensitivity for two types of bifocal IOLs (3M bifocal and IOLAB bifocal IOL) and for a control group of monofocal IOL testing in different levels of luminance simulating the normal environmental conditions of the patient's experience. The results showed a visual functional loss especially at the low luminance level for the 3M bifocal group and at bright luminance for the IOLAB bifocal group, which was previously unknown with and consequences for the indications and exclusions of this kind of IOL.
The optimal management of herpes simplex stromal keratitis and uveitis is controversial. Thirty-two patients with presumptive herpetic anterior uveitis without active corneal inflammation received 3% acyclovir ophthalmic ointment five times daily and acyclovir 200mg orally five times a day. Eight of 18 patients (44.4%) who had received corticosteroids deteriorated over the first five days of therapy; one of 14 patients (7.1%) without previous corticosteroid use worsened during this time (P less than .05). The mean healing time was similar in these two groups. These results suggest that antiviral therapy may be first-line treatment in patients with herpetic keratouveitis who have not received corticosteroids.
Fifty adult aphakic patients were treated surgically by epikeratoplasty. Forty-one eyes had posttraumatic aphakia including 26 eyes with corneal scars. Results are presented with a mean follow-up of 31 months. 64% of eyes achieved an uncorrected visual acuity of 0.2 or better. Best visual acuity was 0.2 or better in 92% of eyes (this percentage is similar to the preoperative figure) and 0.5 or better in 62%. 78% of eyes had a refraction within 3 diopters of emmetropia. 10% of eyes lost 2 or more lines of best visual acuity. Mean keratometric results and spheric equivalent of the refraction show stability of the procedure during a 2 year follow up period. These results confirm, that in selected patients, epikeratoplasty is a valid surgical alternative for adult aphakia.